Many men experience significant erectile problems after having a radical prostatectomy, and many of the men treated by the urologists I work with eventually land in my office. We talk frankly about the quality of their erections before the surgery, what they are like now, and what they have tried to do to resolve the problems they are having. After this, some interesting conversations take place.
“Well, I tried some Viagra but it didn’t work,” is often the response I hear.
I quickly check the record and often fail to find a record of a prescription from the treating urologist.
“Did your family physician prescribe this for you?” I ask.
“Umm, not really… my buddy gave me some…” This is often said without making eye contact.
“Did your buddy tell you how to take the medication correctly?” I ask, with a smile on my face.
Now the man makes eye contact and he is puzzled.
I start to tell him about how the medication should be taken to promote the likelihood of success. Many of the men I see have received and filled a prescription for the drug without any kind of instruction as to how to take it properly. So what usually happens is that they take a pill, and wait for an erection to occur. When that doesn’t happen, they think that the medication is not effective. When I tell them that there has to be genital stimulation in order for the medication to work and that is doesn’t cause an erection but rather maintains one by preventing blood from leaving the penis, it’s like a light goes on.
I also talk to them about how, while their buddy was trying to be helpful, sharing medications is dangerous. I’m not sure how many of the men I talk to then go on to share their pills with their friends—I truly hope they don’t—but perhaps when they do, they also share the instructions!
The other day I learned of a new permutation on the sharing medications story. I saw a man who was interesting in trying intra-cavernosal injections. When I showed him the syringe and needle (an important part of the process because many men imagine something the size of a 6-inch bolt instead of a small 29-gauge insulin needle) he told me he had some needles because his buddy gave him some, along with the vial of medication! This was a new one, even for me after 16 years of doing this work.
“So exactly how did he tell you to use the injections?” I asked.
“Well, he just kinda demonstrated on the outside of his clothing,” was the reply.
“And did you use it?”
“No, frankly, I was slightly scared…”
Fear prevented a potential disaster for this man and I was relieved. I have seen some men who did not receive adequate education (or did not hear what they were told) about using penile injections and the result (at best) is that it does not work and he gives up trying, but I have also seen men who have had to go to the emergency department because they developed priapism from using too much medication.
I spend 45 minutes teaching men (and their partner) how to do this. I use a rubber model to demonstrate, draw up the medication in front of them so that they can see how to ensure that they have the right dose, and then give them a test dose. Their anxiety is high and I have found that this process is the best way to teach them so that they are successful at home, in a more romantic scenario.
More than one man referred to me for additional help when the medication does not appear to be working has told me that his urologist walked into the room where he was lying on the examination table and “grabbed my penis and just stuck the needle in and walked out.” Needless to say, these were not men who were able to use the injection with any degree of success on their own, hence their need to see me for a “refresher”!
A systematic review of this issue published in the American Journal of Public Health1 found that sharing medications was common, with almost 50% of people having borrowed medication from someone else and 23% of people sharing their medication with others. Women were more likely to share than men, and college students also shared frequently. Among older individuals, sharing was less frequent but carries the risk of polypharmacy and adverse drug interactions. Almost all classes of medications were reported to be shared, including genitourinary drugs (although no specific mention of PDE-5 inhibitors such as sildenafil, tadalafil or vardenafil was noted).
This practice appears to be more common than many of us may realize, and we need to think about advising our patients that sharing medication is not a good thing. I was surprised by the findings of this review and from now on will include a warning to my patients about the need to be selfish with their prescriptions, despite their generous natures.
- Beyene KA, Sheridan J, Aspden T. Prescription medication sharing: a systematic review of the literature. Am J Public Health. 2014;104:e15-26.